1831663822 NPI number — FORT DODGE HEALTH, INC.

Table of content: (NPI 1831663822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831663822 NPI number — FORT DODGE HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT DODGE HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831663822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
326 S 25TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT DODGE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50501-4316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-408-2562
Provider Business Mailing Address Fax Number:
312-277-1008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
326 S 25TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-408-2562
Provider Business Practice Location Address Fax Number:
312-277-1008
Provider Enumeration Date:
01/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MOBLEY
Authorized Official First Name:
AARON
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
515-573-2020

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2178673 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06631 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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